Facing the Risks: Complications, Prevention, and Management of Alloplastic Facial Implants in Aesthetic Surgery.

Abstract

Alloplastic facial implants provide durable, customizable skeletal augmentation without donor-site morbidity. However, infection, wound dehiscence, migration, extrusion, neurosensory injury, fluid collections, and pressure-related bony remodeling remain important concerns. This comprehensive review summarizes reported complications and practical strategies for prevention, recognition, and management in aesthetic facial implant surgery. PubMed was searched for studies published from February 23, 2016, through February 23, 2026, that evaluated alloplastic implants used for aesthetic facial skeletal augmentation and reported complication-related outcomes. Reference lists were screened manually. Twenty-two studies were included and synthesized narratively because of heterogeneity in implant location, material, surgical approach, and outcome reporting. Reported complication rates varied widely: infection, 2.6% to 23.8%; wound dehiscence, 1% to 23.8%; neurosensory disturbances, 0.28% to 19%; early fluid or vascular complications, 0.28% to 1.42%; and extrusion, 0.28%. Pressure-related bony remodeling was frequently observed radiographically but was generally asymptomatic. Intraoral approaches were associated with greater infection and dehiscence risk in the reviewed studies. Most transient sensory changes resolved with observation, whereas persistent infection, extrusion, and clinically significant migration often required revision or explantation. Careful patient selection, medical and dental optimization, meticulous sterile technique, precise pocket creation, secure fixation, dead-space control, and structured postoperative surveillance are central to reducing complications and improving outcomes.